1

                                REED TUCKSON

                             November 12, 1996
                            Dr. Fitzhugh Mullan,
                                 interviewer



Mullan:    Your date of birth?



Tuckson:     February 18, 1951.



Mullan:    It's the 12th of November 1996.       We're in Los Angeles,

in the Office of the President of the Charles Drew University of
Medicine and Science.        It's a warm Tuesday in November, and we're
in the inner sanctums of this very handsome building.        The campus
was built when?      Give me just a snapshot of the school.



Tuckson:    The university arises out of the ashes of the Watts

riots of the 1 9 6 0 s .   In that riot, many people died, obviously in
protest for social conditions, and one of the major issues that
was the precipitation for the uprising was a resident of this
community having to try to drive a great distance outside of this
community to a hospital.       The only one that would take poor
people was a long way away, over at USC, at the big county
hospital thirty-some miles away.       As a result of that, there was
an impetus then to create a hospital, and associated with that

hospital was a postgraduate medical education program, which then

became the Charles Drew Postgraduate Medical School.        Eventually,

that evolved into a College of Medicine, which is associated with
                                                                   2

the UCLA School of Medicine, and an independent    School of Allied
Health.
     As a full-fledged university that is fully accredited as a
private university in America, we now have 100 medical students
in our school each year, the mission and purpose of which is to
train the next generation of health professionals who are
dedicated, willing, and competent to serve the health needs of
traditionally underserved communities, and develop new knowledge
in the context of that service.
     So we have the medical school, we have fourteen residency
programs in everything from family medicine through
ophthalmology, orthopedics and such specialty services as that,
and we have an Allied Health School which has nine different
health professional training disciplines, from entry-level office

careers all the way through to physician assistants and nurse
midwives.    So we've been around now about 31 years, as a complete
organization, in one phase or another, but as an integral group,
we've graduated, I think, now 12 classes in the College of
Medicine, and so we're beginning--



Mullan:    And they do the first two years here and then--



Tuckson:    They do their first two years primarily at UCLA, and

their third and fourth years in the medical school with us,

although we begin our curriculum with them from the summer of

their very first year, and have a connectivity with us all the
                                                                      3

way through for the four years, but the bulk of their first and
second year is spent at UCLA.


Mullan:    And the hospital next door?



Tuckson:    The hospital was originally called the Martin Luther

King General Hospital, and now it is called the King-Drew Medical
Center, to designate its very close affiliation with the
university.    We are quite collegial.   Our faculty staff the

hospital.    Our chairmen of our academic departments are the
service chiefs for the hospital department.    So   for the medical
physician services, we are very much involved.


Mullan:    And it's a county hospital--L.A. County?



Tuckson:    It is part of the L.A. County hospital system, with all

of the challenges, frustrations, and opportunities that such an
affiliation presents.


Mullan:    And your students spend most of their clinical time

there, or they rotate elsewhere?


Tuckson:    They spend most of their time there, although, of

course, they will perform electives, particularly in the fourth
year, in scattered environments, but it's a very intensive

experience with us, and part of that core of experience has been

a continuity primary care clinic.   This school has, from its
                                                                       4

inception, been built around a celebration of primary care,
particularly a population-based model of primary care.     Our
students, from the very first moment of third year, are assigned
their patients that they follow for the next two years, in a

continuity experience, and so we've been very big on that.


Mullan:    And the staff of the hospital, it has a medical staff

which is King-Drew, or UCLA, or what are the affiliations?


Tuckson:    The hospital relationship is purely between Charles

Drew University and the hospital.   Again, it's our faculty that
staff it, and the physician staff that works at the hospital is
part of our faculty, in terms of the physician staff.      The only
relationship we have with UCLA is just for those first two years.

They're not involved in our postgraduate residency program
training, nor are they involved in the Allied Health School.      We

are an independent and separate university, but we come together
for those first two years of medical school education.


Mullan:    Let's go back and talk about you.   That's why I'm here,

really.


Tuckson:    Oh, okay.



Mullan:    And if we could sort of move chronologically.   I don't

know, before Howard, where you were.   Were you an East Coaster?
                                                                       5

Tuckson:      Yes, I was a boy in Washington, D.C., and my seminal

experiences that developed my sense of career come very much out
of Washington, D.C.     My parents are both health care
professionals.      In particular, my mother was a visiting nurse,

and so my strongest memories, as a child, are of my mother
getting up early in the morning, putting on that visiting nurse
uniform, and grabbing this enormous black bag, and marching out
into the special visiting nurses' car, and driving into the
poorer sections of Washington, D.C., to take care of needy and

dependent people.
       I keep a picture of her on my desk, because it really forms

my sense of what health care is all about and what my purposes
are.     So she would often come home in the evenings and talk to us

about her experiences.      Generally, I remember bathing babies and
teaching parents how to bathe their children, and concern for
immunization status.      It was really very direct, hands-on care in
troubled and struggling environments.

       My father also greatly influenced me, because he is a
dentist, but he was the founder and chairman of the Department of
Oral Radiology at Howard University's College of Dentistry, and I
am very much influenced by his lifetime of commitment to building
an institution of higher learning for people of color.     He

retired there as an associate dean, and so he has really devoted

his entire life to building this institution.
       So   I'm very well aware of what it means to live a committed

life, dedicated to training people who are going to serve unmet

needs.      There are very few African-American dentists in this
                                                                     6

country who have not somehow or other come through my father's
teaching arenas.    So he's had a tremendous effect on the American
dental landscape.    So as a child of those two people, growing up
in Washington, it is sort of not surprising, although I would
have never predicted, that I'd be doing the work I'm doing now.



Mullan:    What was growing up like in Washington in the fifties?



Tuckson:   Well, I'll tell you, it was a very frustrating

experience.   Washington, D.C. is an extraordinarily--was and is--
an extraordinarily segregated city.   It is a city where you do
not, and did not, really participate in the American democratic

experience, which was bizarre, given that you lived under the

shadow of the American government.
     My parents, I think, first were able to vote for President
of the United States not until John F. Kennedy.   We did not elect

our own government until later than that.   My parents are very

dignified, very mature, and very thoughtful people, and so the
conversation around our dinner table was often a reflection of
our sense of powerlessness and the indignity of being ruled by
people that were not of and from our community and that we had no
say in.
     The racism of the time was a constant feature in our

household, and so a great part of my career has been, I think,
developed from the sense that people of color can and must and

should devote time to public service, and be able to perform in a
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responsible and an appropriate way in that service, thereby
setting to lie the way in which I was raised during those times.


Mullan:    The black community of D.C., at that time, in some ways,

was more integral, or more cohesive--let me take a step back.         At
least my knowledge of black middle-class communities, pre-

desegregation, as has been written about now frequently, were
more cohesive in some ways than post-integration, housing
integration, where it's dispersed.


Tuckson:    Yeah.   I grew up, for the first eight years of my life,

in an extraordinary village, a village of people that, because of
segregation, we were all together, people with means, with some
means.    Nobody was doing great, but people with some means and
those with less means were all assembled in one area.       It's
called in Washington, D . C . ,   it's actually pretty well-known,
called Mayfair Mansions, which is over by the RFK Stadium.



Mullan:    Is that where you lived?



Tuckson:    That's where I lived, right, in Mayfair Mansions.        It

was an extremely exciting place to be, because you had this real
conglomeration of folk.       I was raised in that sense, and when
people talk about, "It takes a whole village to raise a child," I

really was raised in this enclave, in this village.



Mullan:    Mayfair Mansions?
                                                                    8

Tuckson:   Mayfair Mansions.   And if you were to be three

courtyards down and do something wrong, the adult knew you, or
knew what family you were with, and they would call your parents,

and they would tell what you had done, or they would discipline
you and then send you on your way.    So there was a very great
sense of that.
     I also, though, experienced the results of what happens as
integration gradually occurs.   My family was one of the first

families to make the exodus out, and we integrated a neighborhood
in Upper Northwest, not too far from Walter Reed Army Medical
Center, an area that was all white.   I remember vividly all that
goes with the integration of a neighborhood, being called
"nigger" everyday, having racist people drive by your home and
throw things at the house and at you, and the phone calls in the
middle of the night, and painting a cross on your front yard, and
the neighbors on the other side moving out after having built a

nine-foot fence so they don't have to see you, and then they
leave.
     We experienced all of those sorts of things, but we also

experienced the other end of it, which was to watch what happened
as others moved out of Mayfair, and those who couldn't, and who
had fewer means, stayed.   Then over the years, Mayfair Mansions

has become a very entrenched center of poverty, with an extreme
density of hopelessness and not a lot of resources available to
try to find solutions to the problems of the people that are

there.   So we've seen both ends of what happens, and it's an
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interesting metaphor for much of what's happening in American
life today.


Mullan:     That old phenomenon, the irony of integration breaking

the cohesiveness of not urban black life, but urban black middle-
class life, what might have been done differently? As you've

lived through this and watched this and think back on it, and
then watch us as a society move ahead, what is the lesson of

that?


Tuckson:    Well, it's a very tough and complex lesson and

question.     I would say that one of the difficulties of the
African-American experience has been the range of phenomenon that
have served to fracture the bonds that should and could and
hopefully would have given some sense of functionality in terms
of their interconnectiveness. The Jewish community stays

together to a much greater and functional extent, I think,

because, of course, of the tremendous unifying effect of a common
and s h a r e d history, i n s o m e ways a common and shared language

that is unique and different, and then, of course, a common and
shared interpretation of religious life.        Of course, there are
variabilities in that, but to a greater rather than lesser
extent, there is that extremely high-intensity forging of

molecular bonding, as it were.
     The Korean who comes to this country comes with a shared

sense of an entrepreneurial past, of a shared culture, place,

history, language.    You can go right through many, many, many
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different ethnic groups who have a very clear sense of where they
come from, what their language is, what their history is, a
shared sense of religious interpretation.


Mullan:    Even if they're spread out.



Tuckson:     It tends to hold.   The African-American community, of

course, Africans who came here were deliberately separated from
family, children removed from mother and father, father moved
from children, village member "A" moved away to be with people

from a different village or tribe, and so there was this absolute

dispersion of people.     There was no sense of a common sense of
where did we all come from, no sense of place that says, ''1 am
from here.    These are my family roots.    I know what I am."   No.

People were sent, really, into a nether state of affairs.        You
don't know your language, you don't know the folks around you.

No sense of a common entrepreneurial business history.     No common
sense of religious interpretation that is very differently
expressed in all forms of Christianity and it's interpretation as
well as Islam and other religions.
     Much of the African-American experience in the United States
has been one of a searching, for trying to reconnect the pieces.
It's been an incredibly principled--and I'm very proud of the

struggle that, against the most overwhelming odds, people

continue to try to forge those.     And then, of course, as those
bonds attempt to become forged, what is so clear is that the

American experience has been so antithetical to trying to forge
                                                                   11

those bonds, so negative about it, so unencouraging of it, and so
deliberately destructive of those bonds, and so against all these
odds, people are still trying to do it.
     Not to be long about it, but the second part of your

question, with that as a template, is that at the moment that we
begin to move out, it's a result of this Civil Rights Movement
that takes the more overt forms of discrimination and fractures
those, leaving the covert, but for a moment, you are allowed this
great freedom, this sense that you can be an American.   These
families are then able to live the American ideal at a moment
when the American ideal is about to really take off, with all of
its materialistic, narcissistic, self-indulgence, with all of the
dawning of the electronic age, of the consumerism, the rampant

consumerism, the proliferation of toys and gadgets and gizmo,
and, of course, the proliferation of television, which all
happens at that moment.   And, as such, people who have ability,
finally, to approximate the American ideal and have the means to
do it are now able to, after all this subjugation, are able to
finally say, "My kids are going to have everything. My children
are going to be American children. And they're going to go out
and we're going to live this life."
    And so you become part of this great American mass of
confusion, right at the moment that we go into--this is now the

early fifties, and then followed very quickly by the confusion of
the sixties, the Vietnam War, the great disillusionment in it

all, the revolution in culture, and eventually what you get are
people who are now caught up in this great American confusion.
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And all of us are trying to find our way, as a nation, as people.
Nobody knows what they are anymore.   And so African-Americans who
had the chance to escape, escape into this chaos and confusion,
just like everybody else.    So all of us are, I think, in some
ways, we're now part of this larger macro set of forces.


Mullan:    Apologies for going off in this direction, but I think

it's terribly important, and your experience of it so seminal,
obviously the emergence of the underclass center-city African-
American community is clear, as the structure moved out and as
the more organized and more upwardly mobile people moved out, and
that's been written about at great length.   What has never been
clear to me is, as a black middle-class has grown up outside of
the center city, is there cohesiveness to that, or is it so
dispersed--1 mean, it's obviously different than a geographic
community where the kids are three houses down, as you described.
To me, working with and knowing and interacting with black
professionals, it seems to me that there is something of a sense
of community.    I guess it's different, obviously, than the

physical tightness of the geographic community, but speaking for
those who left and the children of those who left, how much of a
diaspora, how much of a dispersion does it feel like, and how
much is there cohesiveness?



Tuckson:    It is very differentially expressed, and so as you

would get in any complex grouping of people, you'll see great

heterogeneity and, unfortunately, I think, not a lot of
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homogeneity.     It's an important question.   But in general terms,
I think that what I see, in terms of how my life is, in terms of
my experiences, is that over time it becomes more--well, let me
rephrase this.    I think twenty years ago, fifteen years ago,
there is a very strong sense of connectiveness between the
African-American middle class and their sense of responsibility,
interest, concern for what happens to those who are not as
economically well off.    That concern is reinforced not only just
by a strong sense of race memory, a strong sense of a shared
history of oppression, and also by the continuing discrimination
that occurs in our lives.     I mean, there's nothing that immunizes
you from American racial realities, even when you are a
professional.     It doesn't matter what your title is.   You still
must walk down the street and go into the shop and confront the
shopkeeper. You still must drive along the city street and see
the policeman come up beside your car.     These are daily
reminders.     You still must listen to the media portray you in
less than appropriate terms.
     The daily experience, the daily sense of rage and
frustration, it's always kindled.    You don't have days where
you're not aware.     I mean, you know who you are when you are in
America.     It doesn't matter what your title is, how much money
you have in the bank.    And if you don't know, it comes at such a
price of self-delusion that you become a very unusual person who

is operating only with so many sensors of their sensory network
out there.     So there is that sense.   You are reinforced.
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        Then there is the sense that so many of have, because we
would go to church back at our local church so you have that
experience.     Or you go to visit members of your family, cousins
and uncles or aunts, who didn't have the same chance, maybe, that
you did as a middle-class person, and are still living in
communities that are challenged, and so you're back in the inner
city.     And then there comes the volunteerism that you do, as
through your civic associations, your fraternal and sorority
organizations that cause you that.     So there is that
connectedness. And then many of us would deliberately have our
children enrolled and involved in things that cause that.


Mullan:     Your daughter going to Spelman is, I would think is a

manifestation of that.



Tuckson:     In many ways.   In many ways, my daughter going to

Spelman College is very much a part of that.     But then over the

last years what is happening, increasingly, I think, is that j u s t
the range of complexities of American life are such that those
bonds become even more difficult to hold onto.     The concern that
middle-class Americans have to preserve their status financially,
and their social status, in a very complex world, causes you to
turn inward.    Just the economic issues, the trying to make enough
money, the fact that both parents or both members of the family

are both working and fully engaged in their careers, the

opportunity and the aggressiveness that occurs because so many

middle-class African-Americans have now been able to go to
                                                                       15

institutions of higher learning that are excellent, we begin to
see, in some areas, erosions of some of the glass ceilings.       So

there is a real push and drive towards career which becomes all-

consuming.
     Then there is just enormity of the social problems that
exist because of the deterioration of the economic base that is
available to try to mitigate problems.    The deterioration of the
school systems, just the fundamental structural inadequacies of
the modern American experience, and the almost complete
unwillingness of America to grapple with those issues at the
level in which something can be done about them, so that what you
get are these little piecemeal solutions to problems of

staggering dimensions, and then you get middle-class African-
Americans who are wondering, "What relevance can I have to these
overwhelming problems?     I don't know what I can do anymore."
Individual action seems to pale in light of the enormity of the

struggles, and so you begin to say, "Look, I've got enough to do,
trying to get my family through this mess.     I'm worried about my
child, and my kids, and I've got to get my career together.       I'm
willing to do some things, and the bottom line is, this problem
has become such a monster, and the chances of success seem so
fleeting, that I just don't know anymore what I can do."    And   so
people begin to drift more and more into just--



Mullan:   Individualism.
                                                                       16

Tuckson:    And the great American morass.     That does not mean

though, in conclusion, to suggest that middle-class Americans
have abandoned sense of responsibility and all of that.       No, that
is not the case.    But I just begin to think that it becomes more
difficult with each passing day.


Mullan:     Let's go back and pick up the young Reed Tuckson in

Washington, in times that are changing.       Take me quickly through
high school, college.     Let's pause at 1968 in Washington, a tough

year.     You were in high school then?



Tuckson:     I was in high school.    I graduated in 1968, and as we

were about to start to think about graduating, in April--


Mullan:    Where were you in school?



Tuckson:     I was at Calvin Coolidge High School, a public high

school, in Washington, D.C., not the best school, but one of the
best public high schools.     It was almost 95 percent African-

American.


Mullan:    Where is Coolidge?



Tuckson:    Coolidge is in Northwest Washington, on Tuckerman

Street, F i f t h and Tuckerman.   That is distinct from Western High

School and Wilson High School, which were more the white schools.

Wilson was, at that time, mostly white.      Western was an
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interesting integration of--really, an experiment, I guess, in
integration, which was pretty interesting. And then the rest of
the schools were almost all black, in the public school system.
Very clearly segregated out in that way.
      But I was in a public school.     Again, my generation,
graduating in ' 6 8 ,   were the generation of the first children to
really start to have a chance to really make it as a group in
American life.     And so, of my compatriots in school, of my best
friends, one is now the chairman of the Department of
Neurosurgery at Howard University.      Another is a very successful
plastic surgeon out here on the West Coast.      Another is a very
successful lawyer who went to Harvard, MBA and Law School, and

became a lawyer, got Milliken out of jail and has done a number
of high-profile cases.       I could really kind of go on, of course,
several others of people.       It was clearly a cohort and cadre of
people who believed that they could do things, and really went

out and did things, and were successful.
     But as we prepared to graduate in 1968 from this public high
school, Dr. [Martin Luther] King [Jr.] was killed, and the city
went in flames.     I remember my parents trying very hard to keep
me in the house, to not have me go out into the streets and
become part of the uprising, and it was a source of tension in
our home, their need to protect me, and my need to be out among

the people.    And so there was a generational gap then.
     This was also in '68, of course, in the heart of the sense

of disillusionment that we had about what America was about, not
only were we, as African-American high school kids, frustrated by
                                                                    18

our growing sense of the realization of race in American life,
but we were also frustrated by just the sense of democracy, that
the president would lie to you, that they would send you away to
fight a war that made no sense, and all those same experiences

that other American children had.    But as African-Americans, we

had our own spin on that, which is very intense.
     So,    as an upshot, we finished our school year with the
United States Army living in our gymnasium, and with the United
States Army filling the entire football field with armored

personnel carriers and tanks and every manner of weapon and gun.
A lot of these soldiers were people that had just gotten back
from the first tours in Vietnam.    First of all, they had to
cancel most of normal school for the rest of the year.    We
graduated in the gym while all this armamentarium was out on the
football field.    Life was very different.
     We had a chance to talk with these soldiers through the

fence.     They were separated from us in some ways, but we had a
chance to interact with them.    So we really had a sense then of
Vietnam, of what they felt, and it was a very highly charged way
to finish high school and to be thrown into adulthood.


Mullan:    Radicalizing?



Tuckson:    Very radicalizing. Extremely radicalizing. And while

all that was going on, Howard University was closing down its

school through student protests, and so we were very well aware,
                                                                       19

and many of us were going down and participating in the protests
at Howard.     And so, yes, it was very radicalizing.


Mullan:     Tell me about Howard.   How was that?   Why did you choose

Howard, and what was it like?



Tuckson:     I chose Howard because, I think, all my life I'd been

programmed to want to go there.      I think I only applied to

Howard.     And, also, financially, my father, being a member of the

faculty, it was very clear that financially that was the place to
go.     And also, my parents were not wealthy.   One of the things

about being middle-class then, for my folks, my father was a
college professor, he was a dentist, but he was a professor, they
didn't have a l o t .   They didn't have a lot of money at all. My
mother, being a visiting nurse, again, you didn't have a lot.
The difference between being okay and not okay was really very
slim.     These are not people with any savings in the bank.     I
mean, everything was going towards paying that house note.       The

margin was very, very narrow, and it would be very easy to slip
back.
      My father, by the way, was the first person from his family
to go to high school, to graduate high school, much less college.
He's an American success story, as far as I'm concerned. My

mother was one of ten children, none of whom went to college,

except for her.


Mullan:    Where were they from?
                                                                        20

Tuckson:    Washington, D.C.    Again, I'm a several-generation

Washingtonian.    So there really was very little margin.    And so,
yes, I went to Howard.    But also I really believed in what Howard
was about and was excited about being there.       It was a very
dynamic place.    I threw myself into--Howard was a protected

world.     It was set of by fences that walled off normal life, and
allowed me to explore and experience anything I wanted to explore

and experience.
     I had tremendous freedom at Howard University.      I was a lot
of things all at once.    I played drums, I was interested in

drums, and Howard allowed me to become a jazz musician.       I was a
member of the marching band.      That was one reason I went to
Howard.    One of the greatest memories of my life--my grandmother
lived her whole life on Howard University property.      My father

was raised on Howard University property.      Her house was rented

from, basically, Howard University.      We lived right there, and we

could literally look out the back porch and watch the football
games from her porch.    So that I was always fascinated with the

Howard University marching band, and it was just the best thing
in the world.    And so one of my dreams in life was to join that
band, and I did, and it was one of the great experiences of my
life, and I had so much fun.
     But then I got into jazz music, and Howard was a place where

so much talent gathered.       So many people gathered together.   So

that all the jazz musicians came through there, and so we

experienced them.    So I played jazz with a lot of very famous
                                                                          21

people, and I got to experience that.     We had a very successful

jazz group there.
     I also became a student leader, non-traditionally, and again
through protest, in my second year.     It was a defining moment in

many ways in my career, in my life, my second year in college
there.    Again, in the spring months, almost when Dr. King died.
I don't remember the dates of this, but I remember it was warm.

Near the end of the term, there was a bombing of little girls in
a church.


Mullan:     In Alabama.



Tuckson:     In Alabama.   There were actually back-to-back incidents

that happened back then, enough such that there was so much
confusion and turmoil and chaos and hurt and pain, that the

administration called off normal classes for the last two weeks

of the school term, and essentially said to us, "You are to go in
your classes, and whatever grades you have now is what you have.
You go to class, and you are to just basically discuss what's
going on in this world, and figure out what the hell it's all
about, and what you're about, and what we're about."      Because it
was just so much disruption.      I can't remember all the details,

but I just simply remember having to go to class, and we would

just talk.
     I remember sitting in zoology with 400 people in this
zoology lecture hall.      It seemed like 400.   I don't know.    Maybe

a couple of hundred, for sure.      It was a lot of people.      It was
                                                                     22

after a week of this, and something hit me, and I stood up in the
middle of the class, and I said, "Sorry, professor, I'm tired of
talk.   If anybody wants to do anything, meet me outside."      And I
walked out.   Strangely enough, like 200 people walked out behind
me, and there are 200 people standing around me, outside, in
front of the school.    And I'm like, "Okay, now what happens next?
What goes on now?"     [Laughter]
      As a result, the only thing I knew to do was to pass out
lists for names and phone numbers and dorm addresses.     Then I'd
get volunteers who helped me collect names.     And there are
lieutenants, and the next thing we know, we had created two
organizations, one called the Organization of Science Majors, and
the other, the PreMedical/ Dental Club.
      Well, it turned out that we had organized all the science
students from that experience.      So all the physics, chemistry,

and pre-med, and the zoology and botany students are all become
organized in this one collective, and we create an organization

that lasts throughout the last couple years of my term.     What it
also did, and what happened in terms of my career and who I am,
was that it brought me immediately to the attention of the
activists in the medical school, so that all of the people that
were closing down the medical school, Howard University's most
probably aggressive medical school class in its history, all of

those guys hear about this Tuckson person, and decide to adopt

me.
      So I now have second-year medical students adopting this
second-year undergraduate.    I get a summer job with them, and our
                                                                    23

summer job is with the National Urban Coalition, one of the first
of these really intense efforts to try to recreate the urban
experience and find solutions to these problems.   And our job was
to figure out how to get more minorities interested in health and
science, and I wound up traveling all around the country in that
summer under the tutelage of a medical student who was the
leader, a guy named Ewart Brown.
     Ewart Brown was an unusually political young man, master
organizer, very charismatic, legend.   We'd go out, and I learned
from him a lot about politics and intellectual thought, about
organizing people and community empowerment, and all those sort
of really very radicalizing skills from him.    Then I also learned

about how you get young children from inner-city communities to
be interested in trying to go into medicine and science.   So I

was employed to do this.
     The upshot of it all is that I get back to school my third

year, and we really do have an organization formed.    Previously
we had no PreMedical Dental Club, so I become the person who
writes away to colleges, medical schools, to get them to come and
interview our kids to go to medical school.    We even gave the
MCAT, the practice MCAT, and I would walk around in the lecture
room with a timer.   We had a lot of people that got into medical
school.   I was the first person to invite the dean of the College
of Medicine at Howard, who never came up on campus, and I walked

him up to interview and to meet his students in the undergraduate

campus.
                                                                       24

     So I learned a tremendous amount there.       I got to be an
organizer, I got to be a musician, a politician.       I got to do a

lot of things at Howard.       And we also met just so many world
leaders.    We had as many world leaders come to Howard as came to
Harvard, probably, during those days.       So there was a real sense

of exposure; experience what you want; stretch yourself out to
the limits; anything, almost, goes.      You could be as aggressive
as you wanted.     The upshot of all this was that I decided that I
thought I wanted to go to health professional school.      I wanted
to be a dentist.


Mullan:    Had this antedated Howard?    Had you gone to Howard with

a notion?


Tuckson:    Not really.   Didn't know what I was going to do.



Mullan:    Had your folks pressured you or steered you at all?



Tuckson:    No, not really.    Didn't say a word, didn't say a word.



Mullan:    Other influences?



Tuckson:    Everybody I grew up with, in terms of role models and

folks that I admired, I mean, the people that came through our
home were almost all professional men--and really men in those

days--and so there was a strong sense of--they didn't have to say

anything to me.    I mean, my sense of who a man was and what a man
                                                                   25

did, these are men of tremendous dignity, of confidence, of
stature, of sense of themselves.


Mullan:    Hold on a second.



[Begin Tape 1, Side 21



Mullan:    This is Dr. Tuckson, tape one, side two, continued.



Tuckson:    The other influences was music.   Again, we were raised

with a very strong appreciation for Mr. [Duke] Ellington and for
Mr. Count Basie and the jazz artists.    I had a great respect for

musicians, because of, again, their sense of their genius and who
they were and their stature and their demeanor, which was a big

part of forming my sense of who I am and what I'm about.
     So I just thought it was expected that I would go into the

family business, in a way.     It turns out I really did not want to

do it, and I made sure, by sabotaging myself on a number of
occasions, that I didn't do it.    I did miserably on the Dental

Aptitude Test, and so I, eventually, did not do that.    And also,
while I so busy organizing the PreMedical Dental Club and helping
people to practice--1 mean, everybody got in but me, to do
things.    So I wound up staying around for a fifth year.

     And what I really did, and it was one of the luckiest
experiences of my life, I really didn't know what I was going to

do after the fourth year, and I hadn't finished one of the major

courses, organic chemistry.    I just really neglected it.
                                                                       26

Clearly, I just didn't know what I wanted to do, in my mind.       I

got a summer job my fourth year, knowing that I would have to
take a summer course.       I could finish in the summer if I wanted,
the summer of my fourth year, and be through, if I just took this
one course.
     I had gotten married at that point, in that fourth year, and

what I did was to get a job, working as a summer intern at the
Area A Community Mental Health Center in Washington, D.C., which
was in Georgetown.    I was just a summer intern doing that work.
Well, this was the most fascinating thing I have ever seen, ever
done in my life.    I was blown away by being in this experience.

I walked in with no psychology course, no preparation whatsoever,
and I'm in the community mental health center.      I'm seeing people
that are paranoid and schizophrenic, and they're walking around,
and I'm trying to understand who these people are and how did
they get to be this way.      My people skills, and my sense of

helpingness, I just bonded with them, and we had the best time.
     They got confidence in me, and they started assigning me to
work with children, and I started working with troubled youth.
That led to the government basically hiring me, full time, as a

psych therapist.


Mullan:    Out of Area A?



Tuckson:   Out of Area A.     So my fifth year, what would have been

college, I didn't take the course I was going to take. I enrolled
then in night courses for my last, what was my fifth year in
                                                                        27

college.    But I worked full time as a psych therapist, a
psychiatric technician, government service worker.        I was
assigned to the children's unit of this outpatient clinic, and I
went around and worked with kids who were troubled in school.           I
met some of the most interesting kids, who were so angry and so
frustrated, and I really started to understand something of the
nature of how people become ill, what the behavioral determinants
of illness really were about.
     One of the children that stays in my mind, who I owe the

most to, was a young boy whose mother had him when she was

thirteen, while she was living in a detention center.
Eventually, he then stays with her mother, who didn't do a very
good job of raising her.      Difficult circumstances.   He grows his
first years in this household, with grandmother. Mama gets out,

has twins that are, like, four years now, later.        Then they all
get reunited and they live together.     She has multiple

boyfriends, and much confusion and chaos.     One day, she goes out
partying all night.      One of the young kids lights a match, burns
the house down, they all die.     He barely gets out.    And on and on

and on.    So,   yes, he beats the snot out of everybody in the
school, because he's one angry kid.
    He and I do great together, but I realize before too long
that I can't--I mean, he taxed the limits of my ability as a

therapist to grapple with his problems, both my conceptual and
clinical understanding, and also the sense, again, of his problem

in the larger social milieu.     It was very unlikely that we were
                                                                      28

going to help him very much through psychotherapy.       I mean, he
had some big issues here that had to be dealt with.
     I also did a lot of Transactional Analysis, and I went out
into a lot of homes, just as my mother had done before me.       I
wound up back in the same homes, in the same communities, that my
mother did, doing Transactional Analysis, with a therapist, with
a senior therapist. We really went in and really worked hard on
a lot of families of these kids.
    And so eventually what happened was, to my luck, the
psychiatrists at the clinic felt like they saw something in me.
They said, "You know, really, you're not a psych technician here.
You really have a little more to offer than that.     You really
ought to be in medical school.   What's going on?" And these were
white psychiatrists from Georgetown.    They endorsed me in a way

that I had never been endorsed, that I didn't know.
     I applied to medical school as a result of that.       I applied
to two schools--Georgetown and Howard.    I will never forget my
interview at Howard.    The dean was very upset with me. remembered
me as a political activist, remembered the people that I hung
around with, who had closed down his school twice.       There was no
chance in hell he was going to give me a chance to go to that
medical school.   It destroyed my father for a while, just hurt

him terribly.   But, to be honest, I also did not have a stellar
academic background.    So it could be argued that I hadn't earned
the right, as well.    But he was not endorsing of me.    The dean

was, in fact, very pessimistic, and screamed and hollered at me.
                                                                         29

It was the worst interview I've ever had in my life.          It was a
very unpleasant experience.
        Georgetown, on the other hand, by the time I actually got

around to applying to Georgetown, it was a little late in the
game.     When all this happened, it was very late, when we finally
got this epiphany that I should apply to medical school.         So

Georgetown had pretty much built its class, and essentially what
happened was that I wound up in a special summer program, a
summer program that had already begun a week ahead of time, with

no promises.
        They basically made me a deal, and this was the deal: "Quit
your job."    My wife was pregnant, about to deliver.      "Quit your

job.    No guarantees.   Come into this summer program a week late.
Do your best.     See what happens."     I do not know to this day why
I took that gamble, but I took it.        I took the gamble, and I was
miserable, and did terrible.        These other students were just
great.     They were outstanding.    The pace was enormous.    But I

took the gamble.


Mullan:    This was like a post-bac program?



Tuckson:     Sort of a summer preparatory course.    I remember, at my

worst moment, feeling completely defeated.       The head of the

program, a pathologist from Austria--I was down, and just
miserable, he just looked at me, and says, "Well, you know, maybe

you can't do it," which completely infuriated me, and I really

worked my tail off then and started doing a little better.
                                                                         30

     End of the story was that there was one guy who had a
placement at Howard and a placement at Georgetown.     He decided
two days before school started that he would go to Howard.          He
eventually went crazy and dropped out of school about two weeks

later.     Amazing.   But it opened up a space, and the dean called

me up, and says, "Reed, do you want to go to medical school?"
And I dropped in on the last space.     There were five black
students in a class of 205 kids at Georgetown.      Five out of 205,
and I was that fifth, and we went on in.



Mullan:     Tell me about Georgetown.



Tuckson:     Georgetown was a very intimidating experience.     I

really was not prepared for Georgetown's program.     I had not
taken biochemistry.     Almost everybody in the class had.    The pace
was enormous, and I was terrified.      I knew I had gotten in on the
skin of my teeth, and I felt like I didn't deserve to be there.

The first year was incredibly difficult for me, and it really was
all about survival, not about learning.     I was not in an

environment where you learn.
     I remember one of the anatomy lectures when the professor
shows a picture of a black man being hung, to talk about cervical
dysplasia.     I remember sitting in the balcony, in the front row
of the balcony, and I wanted to scream out, but I knew that my

status there was so precarious, and for one the few times in

life--and I've never been able to overcome my sense of shame--1

just sat down, and just sat there.
                                                                     31

Mullan:    What was the possible relevance of black man being hung

to cervical dysplasia?


Tuckson:    Just to show neck strain, or whatever.    I mean, it just

was the worst moment.    My sense of powerlessness, and sense of,
you know, just precariousness at that school was such that I just
said nothing.    I barely got through the first year.    In fact, had
to take a course over in the summer, take an exam, an essay exam,
in one of the courses. And so I didn't know whether I was
actually into the second year until the last second.      In fact,
the day the second year started was the day they told me that I
was now a second-year student.    So,   I mean, I barely hung on.
       Meanwhile, I went back to my style of organizing.    I was the
president of the Student National Medical Association chapter.           I
was organizing the students. My music group was taking o f f ,
really taking off.    The jazz group that I started with at Howard
was becoming well known, traveling some, making records.      We were
very much       cultural African-American group for D.C. at that
time   .
       We had started a school, a free school, my compatriots.      We
were all very close and worked well together.     We started a free
school for children that has now become an institution in
Washington, called the Watto School.     Basically it is an

alternative African-oriented school.     So we had just begun that,

bought a house, renovated the house.     Each of us had duties one

night a week to do something.    I did plumbing on Wednesday

nights, cleaned up the place.    I mean, we all had jobs to do.
                                                                         32

Mullan:       This was a collective house with spouses and children?



Tuckson:       We didn't live together.   The house was for the school.

But we bought our food collectively through a food co-op.          It was
all of that sort of thing, back then.        Very much into political
reading, a lot of international readings.        So   we did a lot of

things.
        So   I was trying to balance two parts of my life--the medical
school experience and the social commitment, political part of my
life--and it was a tough balancing act.        And then having
children.       By then my first child was already here.     I just had a
lot going on, and I was overwhelmed.
        Georgetown, back then, was one of those schools that had
just started using the note taking services.          So you had these
very printed-out notes that you studied.        Now, of course, they're
sine qua non of all schools, but this was, I think, a fairly new
thing.       We really studied multiple-choice exams with a note
service.       So it was almost like, if you could figure out, read
these notes, and keep up with it, then you could take the
multiple-choice exam.      And if you knew how to take tests, and you
knew how to assimilate all this information, you could do fairly
well.
     What I did not do, I just didn't have the luxury, it didn't

seem to be available, was to understand the purpose of what I was
learning.       It was, "You've got to pass these tests if you want to

get to the third and fourth year.''       So I was engaged in a
treadmill of just, "I gotta pass this test, I gotta pass this
                                                                     33

test, I gotta pass this test."     I wasn't in a treadmill of, "God,
I'm learning a lot about exciting things and wonderful things,
and just filled with discovery and scientific intellectual
development."
        It turns out that, thankfully, I did not pass the second
year.    I failed a course, pharmacology, which they said I passed,

and I did pass.    Now, again, the details aren't important, but it
just used to drive me nuts, because I missed an exam.     A lot of

people missed the exam.     Everybody saw the exam, those that
missed it.    They asked us did we want to take the exam.   I said,

"1 already know what's on the test."    And they said, "Therefore,

you take an essay."     Well, a lot of my classmates took that test.
I took an essay, and got the worst score in the universe on this
essay exam.
       Then at the end of the course, the guy says, "You didn't get
the Nobel Prize in pharmacology, but you barely passed.     Thank

you.    Good luck."   Well, then, months later, they come around and

tell me I didn't pass the test, the course.     I was just upset.
So I didn't pass.

       It's a debate, and everybody's upset.   So they offered me a
choice at the end of the second year.     "Take the courses in the
beginning of the first semester of the third year.    Take those
courses.    And then the second semester of your third year, you

can go into the clinics and try to catch up with your class.       You
may graduate a few months later.    But it's something.   We'll try

to work it out."
                                                                     34

     For some reason, I said, "NO, I'm going to take the second
year again."    But this time what I did was, I went up to the
pharmacology department and I asked to do research in
pharmacology that summer, as a pharm grad student, honorary pharm
grad student.     I said, "If I fail this course, I'm going to take
it again.     I'm going to be a pharm grad student."   Best luckiest
break of my life.
     And the result of it, quickly, was that I became an honorary
grad student.     I divorced myself from every friend I had.    I
started doing research, and I got a research grant.       The project

required that I inject rats twice a day, seven days a week, which
meant they had to give me a key to the building, and I had to
live in that pharmacology department.     The research was fun, and
all of a sudden, I got around these grad students, who were
really interested in science, and these really smart faculty
members.    All of a sudden, I started reading science, and reading
articles, and reading physiology and pharmacology, and I got
turned on.     I said, "Hey, this is for me."
     So I never once saw one of my friends for a year.       That
third year, I never saw another person that I knew.       I never went
to the lounge.    Nobody knew Reed Tuckson.     I was in the pharm
department.    That's all I was.   And Christmas, New Year's Day,
New Year's Eve, I was in the lab.     I published, and I did work,

and then I finally got into cardiovascular pharm, which really

got exciting to me.
     I got a Heart Association fellowship, and through that, I
met the smartest clinicians at Georgetown, because the hot people
                                                                          35

at Georgetown then were the cardiologists, because it was a
really good cardiovascular pharm, and so there was this union of
the cardiologists and the cardiovascular pharm department.           Well,
I got in with the cardiologists and we really hit it off.            These
guys were so arrogant, so confident, so cocky.          I said, "Man, I
want be just like these guys."         And I went under their wing, and

I just made them adopt me.
       Because of that, by the time I got to the third year, the
real third year, the clinical years, I really knew cardiology
inside and out.      I really knew it.     We had the best teachers, and
I had humanistic teachers.          I knew the art of the clinical exam.

I was taught by this old Southern man named W. Procter Harvey,
who built a stethoscope called the Harvey stethoscope, which I
use still to this day.       Harvey knew more about feeling the pulse,
about examining the pericardium, about all the physical signs.
Which part of your hands do you use to feel what event?         Such
that by the time I got to the third and fourth years, I really

was very well trained.       As a result, I smashed the third and
fourth years out.
       Of my classmates, I was more responsible than almost any,

more enthusiastic, more aggressive, more confident.         Eventually,
I became, like, during my third year, after my medicine rotation

at D.C.   General--and that was everything very quickly.       We used
D.C.   General a lot, and D . C .   General was, for me, one giant

playground, because the university hospital was one thing, but

the general hospital was the other.         I loved the patients,
                                                                       36

because they were my people.       I loved the problems.   They were
all the things I cared about.       I got turned on completely.
     Eventually, what happened was that while I was in my
radiology elective back at the university hospital, one of the
interns in medicine at the general hospital went home to India,
unexpectedly, for a month, for some crisis, and they asked me,
the department, would I be willing to go be an intern for a

month.     They got me out of radiology, a third-year student.    I
became an intern for a month, and that taught me every lesson I
needed to learn.



Mullan:    What were you thinking in terms of career?



Tuckson:     I was going to be a cardiologist, completely, and

that's what I wanted to be.       I wanted to do all of it, from the
technology to the personal.



Mullan:    That's when you went to Penn?



Tuckson:    That's what I went to Penn for.    It was amazing that I

got into Penn, and nobody believed that I could, and that's why I
applied there, and I did.    So   I was going to be there.   When I
got to Penn, and to bring this to closure, I really wanted to be

a cardiologist, and my junior year, I was the admitting resident
in the VA Hospital.    It seems like all my best experiences are at

those kinds of hospitals.     I was the admitting resident, and I
admitted five people in end-stage heart disease, hypertensive-
                                                                     37

based, with tremendous congestive heart failure.      Five-year
mortalities worse than cancers that we were going to see.        I went
to my advisors.     I was in the internal medicine track, the
traditional track.


Mullan:     This was your second year at Penn?



Tuckson:     Second year at Penn.   I went to my advisors, who
happened to have been two very interesting guys, one named John
Eisenberg, and the other named Sanky Williams.     These guys were
the first cutting edge of Robert Wood Johnson Clinical Scholars.
They had gone to the Wharton Business School.     They were policy

guys.     They were general internal medicine guys, and they had the
hottest intellectual center at Penn.     They were really running

fast.
        I had just sort of gotten to know those guys, and I asked

them, why did I admit five people in end-stage heart disease,
from preventable disease, and why did it have to be this way, and
what was I really going to be able to do f o r them as a
cardiologist?     I was going to have a lot of fun floating Swan-
Gantz catheters and measuring pulmonary capillary wedge
pressures, and tuning them up with a few inotropes and
chronotropes, but really was I going to do anything in the real

scheme of things?    No.   And they said, "Hey, you're one of us."

And they brought me into the club, and the next thing I know, I'm

in the general internal medicine track.     I'm under their tutelage

full time, and they gave me complete religion as a generalist.
                                                                         38

       Eventually, I wound up being a Robert Wood Johnson Clinical
Scholar, and staying at Penn, becoming a general medicine fellow,
going to the Wharton School of Business, to learn policy issues,

and those guys are the ones that made me a primary care
generalist.


Mullan:    Tell me a little about the Wharton Clinical Scholar

year.    With your roots in the community, your run of the rapids
of cardiology here, hitting bottom a few times, and then your
diversion into the stream of generalism, what was that conversion

like, beyond the power of Eisenberg and Williams?


Tuckson:    The experience was that just as at Howard, they said to

me, and also Sam Martin, by the way, who was the guy that ran
that program, now dead, but Sam Martin was one of them. Sam
Martin said the most important thing in the world to me, and he

said this, "You were chosen for this program because we believe

in who you are.        You don't have to do anything other than for the
next two years to follow your h e a r t and your mind.    Whatever

you're interested in, do it.       You don't have to come report to me

about anything.        You don't have to tell me anything.    You were
chosen because you, Reed Tuckson, we believe in.         We believe in

you.    Go f o r it.    See you later.   Have a good time."

       And he opened the door, and I wound up then doing everything
I was interested in.        So I became a consultant to sickle cell

disease, because I was infuriated with the way that the poor

black kids were being treated in the emergency room and how inept
                                                                     39

we were at managing this disease.     It taught me a tremendous
amount about the interface between behavioral, social conditions
and the clinical manifestation of disease and the expression of

pain.     I got very immersed into that work.    I was the medical
director of a skilled nursing home in the inner city.      I
basically was the founding medical director, and that got me
into--



Mullan:     This is the Jeffries Nursing Home?



Tuckson:    Yeah, the Elmira Jeffries Nursing Home.    This was a lot

of responsibility for a young physician in training, and it

taught me a lot about the organization of health services, the
financing of health services, but also how you deliver health
services out of the real world.    That was seminal.

        I was in charge of the Student Health Service, the night
service for student health, and so that gave me a whole
experience in student health, in college health, in adolescent
health, and again, how do you organize systems of care.
    Most of my passion, though, was in a preventive medicine
radio show that I did on the jazz station in Philadelphia.
Philadelphia had a very popular jazz station called WRTI, The
Point, 90.1 FM.    I created a radio show with one of my
attendings, who was a great guy, and that radio show we did every

week, but we did it using theater, drama and comedy.

     One of my best friends was a playwright, so we used to do

skits on the radio, and we had actors that would come in with us
                                                                       40

and do it.      So it was hilarious or it was sad, but it dealt with

topical issues, and it would start out with, "NO, you're not
putting my mother in a nursing home."

         "But dear, she left the door open and walked out three
times, and she left a pot on the stove, and it was boiling, and
I'm worried about her."
         "Yeah, but my mother was there for me, and I'm not giving
up. Ir
         "But dear, we can't manage your mother.    She's in danger.     I

know we love her, but we got to do the right thing."
         "But that's my mother."

         And they'd go back and forth, and then we'd say, "Welcome to
The Point, 90.1 FM.      How do you make a decision about your mother
and a nursing home?      Well, with us today is an expert on so and
so, and now let's talk about the issues that came up in this
drama today."     And then we would go into it.
         So we would do these things, and it taught me all the
lessons that I still use every day about communicating preventive
medicine issues to constituencies of people.        So all that stuff.

And, then, of course, I had my panel of patients that I was
seeing, and all the experiences clinically.        And so all that
gamisch came together.



Mullan:     How did that translate for coming back to D.C. and

jumping back into the public sector?
                                                                         41

Tuckson:     I was fortunate that some of my oldest advisors and

mentors in Washington, D.C. were tracking my career, and a guy
that I call my coach, who now must be seventy-five years old, a
neurosurgeon who is now the professor of social policy at Howard

University School of Medicine, Dr. Jesse Barber, Dr. Barber
called me in the spring of my second year, and Dr. Barber said,
"Reed, it's time for you to come home.         There's a job for you to
be the special assistant for medical affairs to the Commissioner
of Health here in Washington, D.C.      Your city needs you.    This is
what you've been trained to do all your life, and this is what
you're to do    .   It's time to come home."
     So    I looked to my professors, and I said, "I've got to leave
the fellowship early.     What do you think?" And, to a man, Sanky,
John, Sam Martin, they all said, "This is what you were trained
to do.     This is why you're here.   Go.   This is exactly what's

supposed to happen."      I thought they were going to be angry.     I
was scared.     "Everything is unfolding as it should.     Leave."   I
can't believe how wise those people were, how they understood.
     So I left, and I became special assistant f o r medical

affairs.    And, of course, all of those years at my father's home,
and the sense of--and that's what all that earlier conversation--
that's why, I guess, it was about.      It turned out to be a
terrible experience.     The Commissioner of Health was an idiot, as

far as I was concerned, not interested in health.



Mullan:    Who was commissioner then?
                                                                       42

Tuckson:     I'd rather not.    But just to say that I did not enjoy

working for him.    He was anti-intellectual.     It was an unexciting
place.     Coming out of Penn, with this sense of enthusiasm and
knowledge, the use of data and studies and analysis and applied
theory and all of that, to a place that was really a stuck
bureaucracy, a government bureaucracy, with no vision, no
passion, just a real political Machiavellian-ness, where the
whole subject of every conversation was, "Who's in power?       Who's
on first? Who's on second?" as opposed to, "Who's sick and who's
dying?''    I just was furious.
     And also, the guy that was the commissioner really had
reason to be scared of me.       I mean, I was well trained,
enthusiastic, and he was fearing for his job.      So I got sent to
suburbia in this job, and essentially what he did was to make me
do things that were finance-related and business-related, which

was just perfect, because I then really got to understand the
financial underpinnings of this modern public health system, and

I really got pretty good at knowing that stuff.      I quit, though,
after about four months.       We had a terrible falling-out.   I

screamed and hollered at him, and he screamed and hollered at me.
I said, "I'm outta here."
     Very luckily for me, people had noticed me in the four
months I'd been there, and so I got a call from a guy that ran

the Department of Human Services, said, "The mayor and I don't
want you to leave government.      Come over."



Mullan:    This was the mayor of Washington?
                                                                     43

Tuckson:   Marion Barry. who I had a great deal of respect for at

that point, because he was very active and very interested in
things I cared about.   We don't have time to do Marion Barry in
this interview. A very complicated man, but not all the
unidimensional figure that he is portrayed to be in public, even

though he and I had a falling-out as well.      This is a very
complex man, not at all easy.    He's not black and white, as he
was made to be in public.
     Anyway, the result was, though, that they offered me a job
in the Commission of Social Services as the administrator of the
Mental Retardation/Developmental Disabilities Administration.        I

could not have been luckier to have gotten a position like that.
First of all, it was administratively the worst-run and most
troubled administration, probably, in the system, so I had real
problems to fix.   And so I had all this theoretical knowledge,
but I'd never really run anything.    So   now I learned to run

something.
     The thing about the Mental Retardation/Developmental
Disabilities Administration that was good, were two things.        One
was, it was run on the developmental model, which is antithetical
to the medical model, that the clients that we were serving were
not medically ill, and they and their advocates adamantly
advocated that these were not ill people.     They were

developmentally disabled, which meant that they hated physicians.
They absolutely distrusted completely the medical establishment.

They believed in this whole developmental model which dealt with

the entire human being.     So I had to put my "M.D." in my back
                                                                    44

pocket.   Not only did it not mean anything to be a physician to
them, it was a liability, which was a risky thing at that moment
in my career.
     What I then became enamored by was a system that assessed
the individual's mental, physical, dental, social, recreational,

economic, every element of that person was part of the individual
treatment plan for that individual person.   And the second part
that was so exciting about being in the mental retardation system
was that it was at the height of the moment of depopulating and

closing the institutions, and placing these folks in the

community, in small group homes.   So my job was to create a
system of care and housing for developmentally disabled people in
the community.
     Well, politically, the lessons to be learned were the most

intense lessons as you can learn anywhere, because property value
politics, "not in my neighborhood," is the most intense politics

you can ever get.    It didn't matter whether you were putting

these group homes in a poor community, or the richest community.
You had a hell of a battle on your hands to do it.    And so I got
a really great education in how do you go out there and deal with
people in a community environment, and talk to them about things
that they do not want to talk about, and survive.    By the way, we
were number one in the country at our success rate at creating

group homes during the time I was there.   That's not just because
of me, but because of the advocates that we had, and so forth and

so on.    I also learned a lot about advocates.   I learned a lot

about advocates.
                                                                        45

Mullan:    Strong advocates.


Tuckson:    Strong, boy.   And they were on our case.   I learned a

lot about what it means to work with advocates and to determine

why is it that you're arguing with each other.     If you both want
the same things, is it a question of technique, style, pace?        I
had a very good relationship with the advocacy community, and it
turned out, again, to be an important lesson.
     So at the end of the day, what you began to realize was that

as we study this from a population health perspective, if you
think about it, the people that you see homeless on the streets
are not the mentally retarded, they're the mentally ill.      The
mentally retarded system, and especially the developmental
disabilities system, was able to depopulate their institutions,
close them down, to a great extent, but not have people lost.


Mullan:    The group home movement was much more effective.



Tuckson:    It was extremely effective.   And, again, what it was

all based around was this individual treatment plan that looked
at the comprehensive needs of the whole person.     So I have seen

it work, I know it works, and I know the value of it, and those

lessons are critical to me in terms of my interest in primary

care.



Mullan:    The end of that, you went back to Public Health.
                                                                     46

Tuckson:    The Public Health Commission was not doing well.   They

had, by that point, another Commissioner of Health, who was a
good man, struggling a little bit.    The mayor asked me to go over
as the Deputy Commissioner of Health, to help with some of the
infrastructure and the business-side issues.    I had really

learned a lot about managing in the public sector by this point,
and knew a little bit about it, and knew a little bit about what
to do, and knew the players in the system enough to be able to
make a difference.    Had a fairly good reputation.
     So    I went over as the deputy commissioner.   I was glad it

was a step up, and enjoyed that experience somewhat.     Still had
some differences of opinion with the people I worked for, still
an impatience to get some things done, but still good.
     At that point, a job opened up, I became aware of a job in
the private sector for a major pharmaceutical house in New York,
to work there.    I had been to business school, I had done the
public sector stuff.    I thought I would have fun and go do that.
I interviewed for that process, but realized that the j o b they
offered just wasn't exciting enough, and said to them, "NO," and
I told them I didn't really have confidence in the people that I
would have been working for in their system, didn't think they
were very good, told them why.

     Came back home, spent some more time as deputy commissioner.
Got called again by the drug company, that said, "We'll hire you
as the medical director of this division."    It's a fairly popular

name--1 can say it now--it's the people that make Bayer aspirin
and a few other products in that field.    That was just at the
                                                                     47

moment when Bayer aspirin was getting ready to be marketed as an
anti--to be used in prevention of myocardial infarction because
of the effect of aspirin, in terms what it does in terms of
clotting.    It would have been a very exciting moment for a non-
prescription drug, over-the-counter, to be marketed this way, and

it was a tremendous exciting opportunity, and I'd make a lot of
money.    I was making diddly-squat in public service. And I'd be
on 90 Park Avenue, in New York.       I mean, it was just the most
exciting thing in the world.
       I was really revved up, and I sat down with the mayor and
said, "Mr. Mayor, I enjoyed working for you.       This was just

great.    I'm outta here."
       Then he says, "Well, look, how much money is it going to

pay?
       I said, "Well..   .'I




       He says, "That's pretty nice.     I can't pay you anything.
You can't make money here.      But I don't know how long our

commissioner's going to last here.       I think he has other
interests he wants to pursue, and I'll tell you this, you'll be
the next Commissioner of Health if you stay, and you know what
your commitment is.       You know how you care about this city."
Anyway, a long story short, the hardest phone call I've ever made
was to say to those folks I wasn't coming to New York, and I hung

around, and the mayor was good to his word.



Mullan:   How long was it?
                                                                        48

Tuckson:     I guess it must have been another three months or so

later, and I did become--


Mullan:     Took over as Health Commissioner in 1986.



Tuckson:     I took over as Health Commissioner.



Mullan:     Four-year run.



Tuckson:     Four-year run.



Mullan:    What was it like?



Tuckson:     Oh, just tremendously exhilarating and frightening.        We

were in the midst of the mayor being investigated, and the
department that I was in, Health was not a separate department.

It was part of the Department of Human Services.        There was a l o t

of scandal, or alleged scandal, in that department, contracting.
The lions were out, the media was all over the place.        The U.S.
Attorney's Office investigated everything, so that I was
terrified all the time, because I had no idea about what was
going on.     I didn't know where the problems were.     I didn't know

if I was in any of it, unwittingly.     I didn't know if a contract
that we had signed was inappropriate.     Just fearfulness about

this scrutiny.     I had a full-time reporter from the Washington
Post basically assigned to me, for my department, so that we were

in the newspaper every day.     Our issues were there.
                                                                       49

      And then to be frank, I pushed our issues onto the
newspaper, because I very clearly understood the role and the
potential of the bully pulpit as the Commissioner of Health, and
I really did make love to the media.     We were very aggressive.
If there was any slow day in the news, we told them, "Come see
us.   We will always have a story."     Heat stroke alert, you know.

We would go out and we would do all that stuff that I learned
from my preventive medicine radio show.     We applied it every
chance we could get.    We talked health 'til we were blue in the
face.     We would go anywhere, anytime, and educate.   We had no
money to do health education, so we used the public service time.
      We had such good relationships with people like the NBC
affiliate, WRC-TV, because we were so prepared and so eager.        We
would go in and do public service announcements constantly.       We
usually could get it done in one take, so we didn't tie up the
technician.     We really were ready.   We'd go in and we would do

it, and they were good.     They were good PSAs, and they would put

them on, and so we just had all this free--so you could not go
anywhere without encountering Reed Tuckson, in your face, talking
about health.    And we did the health fairs, and we were just
tireless.


Mullan:     What about the frustration working for a decrepit

government in a down phase?



Tuckson:     It was very frustrating because the budgets were cut

every year that we were there, and every year I was there we lost
                                                                   50

people and had to downsize. Most of the time we were there, the
budgets were frozen, so even when they weren't cut, we were not
allowed to spend money, even federal money, because everybody was
terrified about being able to balance the books.   Then they would

let you spend money for like a month.   You could only get it out
for a moment.   So then you had people saying, "Well, you're not

spending enough money on AIDS."   And you're screaming and

hollering trying to expend your AIDS money, but they locked the

books up, across the D.C. government. You couldn't get your

money out, you couldn't get your people hired.
     It was a tense experience.   Very difficult, so much so that
the best example that I can capsulize it was, of the bad and the
good of what happened to us then, after a number of budget cuts,

we had lowered--one of the major priorities we had was infant

mortality.   We decided that the health of babies and mothers, on
the scale of civilizing values, this was at the top, that and HIV
disease, because that was at the height of the HIV emergence.      So

we said, "Look, the Children's Defense Fund--" My experience
with advocates was, again, I embraced the advocates.   Bring the
advocates into the process.   Bring the community into the
process.   That has always been my learning, from my mental
retardation days.   So the Children's Defense Fund was critical as

hell of the D.C. government and their mortality, and our

statistics were the worst in the world.   So we said, "Look, come

in and tell me everything that's wrong with our system."     And

they gave us, "This is wrong, this is wrong, this is wrong, this

is wrong, this is wrong."
                                                                     51

        We said, "Fine. We're going to do the opposite of
everything we're doing wrong."     So   we guaranteed any woman would
be seen within two weeks of the date of their call, for a first
trimester visit.    We guaranteed that there will be no more block

appointments, but individual, scheduled appointments, no herd
mentality.    We guaranteed clinics would be open on Wednesday
nights from five until nine, for those that were the working
poor.     We guaranteed on and on and on.



Mullan:     Could you deliver on those?



Tuckson:    We absolutely did.   And the Washington Post didn't

believe it, and they said, "We don't believe you're doing it."
        I said, "If I do it, you have to write the editorial that
says we did it.    And if we don't, you're going to beat the hell
out of me, anyway.    But I want that commitment."    They had all
the women in the "Metro" section, what I learned later--at least
I was told--to call in for appointments, and they got their
appointments.
     Now, by the way, and one of the lessons I learned, that I
use to this day, is the importance of the receptionists and the
people that answer the telephones.       I trained those people

personally, personally went out and trained those people, and I

told them, "You're the most important people in this whole damn

Department of Health."



Mullan:    Did you get your editorial?
                                                                        52

Tuckson:    I got my editorial.   I got my editorial.     I was right.

The Washington P o s t made it possible for me to be successful as
the Health Commissioner.    I'll say that unequivocally.     Somewhere

in that system, they made a decision to let me be successful.
They could have made a decision for me to fail.        They have that
kind of power.    Somebody in there--1 don't know who it was, and
to this day I don't know--1 don't know how it works, but they

said they were going to give me a chance.     They had watched me

all through my career.    The first week I was at the Mental
Retardation/Developmental Disabilities Administration, there was
an editorial.    The first decision that I had to make was very

controversial, and the P o s t wrote the editorial.     I still keep it

to this day.     "And if you think it through like Dr. Tuckson,
you'll agree with him, as we do."      They validated me that moment,
and from that moment on, they validated me, throughout it. And

so I was lucky.


Mullan:    What was it like, personally, to come back to home town?



Tuckson:     Pressure, pressure, pressure, pressure, pressure,

pressure, pressure, because everything about my operating was in
the climate of "Black people can't run anything.        You guys aren't

smart.     You don't know how to it.   You'll fail."    And now

everything you'll say about the government was, "You'll fail."

And my parents and everyone--



[Begin Tape 2, Side 13
                                                                        53

Mullan:    This is Dr. Tuckson, tape two, side one.

      You were saying about pressure.


Tuckson:   Yeah, the pressure was that, again, having been raised

as I had been raised, with all those figures in my home, and all
that frustration and expectations from my parents, I could not
afford to fail in this job, and I certainly could not let down
all those people that believed in me.      And each day that we used
the bully pulpit and went out there, and the people in the city

really liked what we were saying, and they really identified with
me, so that everywhere I went, cab drivers, doormen at the
hotels, every time I'd go to a conference, I mean, everyone I
would meet would say these nice things about me.
      So every nice thing that was said turned the pressure up

another notch every day.     So I felt like I was carrying the
weight of the world on my shoulders, and so if there was a bad
article that was going to come out, I lived in just agony that I
would embarrass myself or let down the people that believed in
me.   And then, my mother and my grandmother and my father lived
there, and so they were getting phone calls every night about
their son, or grandson. And so, any bad story--so I fought every
article until that article went to bed.      I called in to the

editors.    I had that really intense relationship with the P o s t .

I mean, so that if they said something, I would argue every point
until the paper went to bed.     I mean, I was a real pain in the
butt to them.    I fought every line.
                                                                    54

     And then the radio stations had my beeper number, and that
was fine, because any article that came out that morning, they
called me 6 a.m., and I got on the radio, on "Drive Time."      I

would be interviewed, all the time, regularly, which gave me the
chance to get the health message and the political spin that I

needed out on every air show, because we also had the Washington

T i m e s newspaper, which was the Moonie paper, and those people

were rabid racists.   They were crazy, and they did anything they
could to kill you, to destroy you.

     And so, anyway, the bottom line was that at the end of all
this, one of the best things to happen to us was, they cut my
budget, which meant that we had to stop most of the things that
we were doing for prenatal care, especially our flagship program,
which was the evening clinics, which we were supporting on

overtime. And all the overtime in our department went to the
police department, for the crime wave, and to the corrections
department, to take care of all those people that got locked up.
So I watched them take away the money from babies and poor
people's health, and put it into the criminal justice system, and
I went berserk with anger.
     I remember having a staff meeting with my staff, my senior
executive staff, and we were depressed, because the crack cocaine
epidemic had just started to really hit, and our infant mortality
rate, which we had really brought down, started going back up.
Then they canceled out my programs because of the money problems.

We were so glum, and we were just so crestfallen, and nobody
could speak in the staff meeting.    And just like at some of the
                                                                     55

moments in my life when you're just completely down, all of a
sudden, you just throw something out, you just say something,
like, "Everybody come outside.    Come outside, follow me.   I don't

know what I'm going to do."    And I said, "You know, let's open
the clinics ourselves, the executive staff.   We will run the
clinic every Wednesday night.    I'll be the doc, and Marc Rivo (my

deputy for prevention services), Marc, you'll be a doc, and my
chief nurse advisor, you be the nurse."   And my Deputy
Commissioner of Health was a social worker.    "You be the social

worker.   And the budget guy, the finance guy, you are the
receptionist. And the health policy guy, you are a
receptionist." And we created a whole team.      "And the guy that
runs the drug program, you come be the drug counselor. And the
nutritionist lady, you give out the WIC program stuff.    We won't
answer any more memos from stupid politicians.    We're not doing
any stupid bureaucracy work.    We're just not going to comply.

We're going to take the time we would do that and we're going to
go out on Wednesday nights, from five to nine, and we're going to
run this clinic."
    And that became the best thing we've ever done, that I've
ever done.    It made the most sense, and we really learned how,
then, to be good administrators and public policy people, because
we were doing it every day.    The guy who did the procurement saw,
in real life, what happens when the medicine runs out at the
pharmacy.    He now knew what it meant to move that paper and get

those drugs out of the warehouse.   Everybody learned a whole
                                                                     56

other level of how do you do your job, and, spiritually, it was
great.
     Then what we did, just to really have fun, was then we
played tennis every night at the tennis center from ten to
midnight.     It turned out to be Wednesday night was the highlight
of our lives.    We did the best work, learned the most, gave the
most back to the citizens, and we became heroes.       That clinic
went on for years, and I think it's still going on.


Mullan:    Marc was still staffing it, I know, for a long time.

Any problem running out in front of the mayor, in terms of your
publicity?


Tuckson:    Yeah, I was hated, distrusted.



Mullan:     In the mayor's office?   By the mayor himself, or by his

handlers?


Tuckson:    By his handlers and other people in the system who were

jealous that I was successful. Basically, there were only a few
of us that were successful, and I was distrusted, and people
wondered what my motivations were, and there were people that

really would like to have seen me fail, and I can understand

that, and I didn't care one bit, because we pushed hard.



Mullan:    You were there when the mayor got busted?
                                                                        57

Tuckson:   Right before.   The upshot of your last question, the

upshot of being out in front, the mayor said to me, "For the
fourth budget cycle, we're going to cut you even more, and you
can go out there and sell it, because those people believe you."
     And I said, "NO, Mr. Mayor, I'm not going to do that.         I
can't do that.    It's already too far.    NO."
     We had a big meeting in his office, with all of his senior

staff, with his budget people, and I said, "Mr. Mayor, you're
being poorly served by these people."       I really got upset.    "I

mean, these people don't know what theylre doing.       They are
terribly advising you, and I know you would not make these

decisions if you could hear what I am saying.      Listen to what I
am saying to you.''   I got very upset.     It was at Christmas time,
right before Christmas, and I stormed out, pretty much.
     The mayor yells back at me, you know, something like, "Dr.
Tuckson, keep hope alive," or something like that.

     And I basically made an obscene gesture and walked out.

Well, I knew it wasn't going to take long before the security
detail kind of asked me to step into another room, and the mayor
walked in, and we had a one-on-one.       I told him I was quitting,

that I was through, that I'd had it.      He asked me to think about
it over the Christmas holidays.    I said I would.
     Well, the way it works in real life, and I learned a lot is,
I'm driving to work on January 2nd, in my car, and I'm tuned to

the radio, and the radio says, "Rumors are that Dr. Tuckson is

planning to leave, is going to leave, and is leaving as Health

Commissioner.I'
                                                                        58

     Well, my God, I pick up the phone, I call the mayor's
office, I said, "I've got to get to the mayor immediately.          I
didn't say a word, Mr. Mayor, to anybody.      This has been
completely--1 mean, there's a story out.       I don't understand
what's going on.    I know I didn't do it.     I don't want you to
think that I'm playing this kind of game with you," and so forth

and so on.    Well, clearly, it came from him and his people, and
they did it.
     Next thing I know, there is a flood of activity all over the
department.    The news media is now coming out, basically saying,
"We're concerned that Dr. Tuckson is leaving."      An   editorial in

the Washington Post that says, "Don't go," which really pissed

them off at that point.     [Laughter] So I was in trouble, and
friends of mine in the system said to me, "There are people down
here looking at every contract you've ever signed," and I got
terrified.

     It turned out, by serendipity, that about two months before,
I gave a talk to the March of Dimes in some regional meeting of
theirs.    I don't know how I got invited.     I didn't really feel

like going.    It was up in Connecticut.     I had to go on a plane, a
Saturday afternoon, I was tired and didn't want to go.       But
anyway, I had to go, so I went.     In the audience was the new
incoming czar of the March of Dimes, president of the March of

Dimes.    She was in her training year, learning the March of

Dimes.    She hadn't really taken over y e t , and she was in the

audience for this talk.
                                                                     59

     One day, about a month after I gave the talk, she appears in
my office.   They said, "Dr. Tuckson, the president of the March
of Dimes is here."
     I said, "Oh, hi, what are you doing here?"
     She said, "Listen, I just want you to know that I really
respect you, and I'm interested in what your ideas are.     I know
you have no plans on leaving your job, but I just want you to

know that if you ever thought of leaving, there are people out
here who really care about you, and would be interested in
talking to you, and I'm one of them.     I just wanted you to know

that."   And she left.
     I'm sitting there, dumbfounded. Again, I can't believe that
anybody has taken this time to validate me.    I have no sense of
who I am, in the scheme of things, and not overwhelmingly
confident, really, about what I'm doing.     I mean, there's a
crisis all the time.     And this person drops out of the sky.
     Well, end of the story is that they tell me that there are

people looking at contracts and doing stuff, and I don't know.
They said, "Reed, welre really scared that people are really
trying to embarrass you.     They're going to try to humiliate you
and tarnish you."
     I immediately picked up the phone, called this lady,
Jennifer Howse, president of the March of Dimes.    I said, "Are
you still interested in talking to me?"

    And she says, "Yes."

     I said, "Well, look, I'm prepared to get on a plane in

another hour and be in New York."
                                                                   60

     She said, "We'll have a car waiting."
     I go up there, we have this conversation, she hands me a
piece of paper, handwritten, with the terms of a contract, the
most unbelievably wonderful contract I have ever seen, giving me
responsibility for all the community-based programs of the March
of Dimes, in 140 chapters around the country, some real
community-based public health and primary care-oriented services.
I'm like, 'lWhoa!'l Giving me responsibility for the political
agenda and the Washington political office, responsibility for
one the world's most aggressive research agendas in molecular
biology and immunogenetics, responsibility for a public policy

think tank.    Wow, unbelievable! And a great corporate culture to
be in.    And before you know it, I'm doing this job.



Mullan:    And that was Connecticut-based?



Tuckson:    No, it's actually in White Plains, New York.



Mullan:    So you had to move?   [Tape recorder turned off]



Tuckson:    So, yeah, March of Dimes was a great experience.   I

told you the things that I was able to manage.    I learned a great

deal about American communities in a way that I had not learned

before.    My experience had been in poor communities.   Now I'm

falling into a national agenda, and I'm travelling all around the

country, working with many cultures in different, diverse

communities, with suburban communities, as well as inner city
                                                                      61

communities and rural communities.      I'm in Minnesota and Wyoming
and Montana.      You name it, I'm out there, all over the country.
     I learned a great deal, again, about the American
experience, how Americans are organized, and the goodness of
Americans, and how Americans are really trying to form a sense of
community, and how those issues relate to whether babies will
live or die.      The last thing I learned a great deal about was a
re-invigoration of my sense of appreciation for the American

molecular, biological, and scientific establishment.       The
incredible intensity of that experience, the genius of American
science, and the enormous pace with which American research is
conducted, the half-life of ideas, that brought me right back to

the beauty of when I had been doing my research in the Department

of Pharmacology, and I really was appreciative of that.


Mullan:    So   where did the Drew idea come from?



Tuckson:     Dr. Louis Sullivan was the Secretary of Health, and

called me one day to tell me that, in his opinion, there was an
American tragedy unfolding. At Charles Drew University, one of
four black medical centers in the country, their president, a
wonderful man, had suffered a terrible car accident at a moment
when he was just starting to get Drew to be what it was destined

to become.      He was incapacitated for years.   While they were
trying to see whether he would be able to return to his position,

an interim president--eventually, the board made a decision that

they had to move forward with new leadership, and Lou Sullivan
                                                                       62

told me that I needed to go and experience and see it, check it
out, and let them see me.      Again, a very validating experience.
        I had no sense that Lou Sullivan would ever pick up the
phone and call Reed Tuckson and say anything.      I had no idea that
anyone thought of me in that stature.       I was amazed.   It never
even came to my mind, being a president of a university, doing
this.     It just wasn't even in the scheme of things.
      And I came out, and once having seen it, my father's legacy

smacks me square in the mouth, building an institution.          The
institution was in some need, and I felt like maybe I had
something to offer.       The board did, and so I wind off jumping off
the edge of the Earth, again just complete risk.       I didn't know a
s o u l in California.    I had been divorced since this time.    I had
just met a new person only months before, in Atlanta, Georgia, on
a trip to Atlanta.       Having a relationship, trying to build a
relationship with this lady and her son, who was twelve at that
time, from New York to Atlanta, only a few months, and now all of

a sudden having to decide whether I would take this job, yes or
no.   And so she decided to enlist with me.     Our son decided to
enlist.    And we just jumped off the edge of the Earth into the
great unknown, all the way across the country, without knowing a
soul. And so I became president.



Mullan:    And you had been divorced in Washington or in New York?



Tuckson:    Washington.
                                                                       63

Mullan:    So an awful lot's gone on in these six years.      I'm sure

we could spend a morning on that alone.      Why don't you
encapsulate for me what the principal issues have been for you

here.


Tuckson:     The issues here have been, first, trying to create an

infrastructure that can sustain the vision of the school.        The
vision of the school is completely perfect for our times.        It is
a vision of population-based medicine.      Because we'd come out of
a community ethos, the people that died, or the relatives of the
people that died, and the leaders of the movement to create the
medical center are still alive and are actively involved in a
daily basis in the life of the school.      They are on this campus
every day.     It is an extremely intense relationship with the
community.     This is not theoretical in any way, and it's a very
dynamic community that is extremely intense.


Mullan:    It's like having your parents watch you be Health

Commissioner.


Tuckson:    Exactly right.   Thank you.   Very much that.    And so the

population-based principles are very clear for us.      So the notion

was to take the university and build an infrastructure that was

not as focused or preoccupied, only in service to underserved

communities, but to develop new knowledge in a context of

service, to put an intellectual, academic dimension to our

training.
                                                                          64

Mullan:    Which had been lagging?



Tuckson:    I think so, yes.    It had been lagging. Very dedicated

to that.


Mullan:    How many years into the scllool's life?   What year   (   id

the school actually start?


Tuckson:    Let me give that to you, just because I always block on

these numbers.    The beginning origin--thirty years ago.
Basically, when I got here, it was the twenty-sixth year.


Mullan:    We're talking mid-sixties when it started.



Tuckson:    Yeah, right, 31 years.   Technically, and then really

getting in, in the seventies, through the medical school building

being built in the middle seventies, early eighties.     But, again,
like I said, thirteen, fourteen classes in the medical school
having graduated now gives you a sense, but the real thing of it
is, that it was really based around a county hospital.
Everything here was based around a county hospital.
     The lovely people, the lovely, dedicated, heroic faculty are
people who really went to work in a county hospital, to serve

those that needed service.     These are wonderful people.   But what

they were not here as so much f o r was the academic purposes, more

f o r the service purposes.    The academics were really sort of an

add-on. And so we've had to spend a lot of energy putting the
                                                                    65

academics now before the service or as part of the service, so
that they're all related, bringing in a new kind of faculty that

really is committed to teaching.
    A lot of that was that we had a deficit here when I got here
of $3.5 million cash, so that was a big issue for us.    And then
we were a school that was going through the final stages of

accreditation.     It was not fully accredited as a university, and
so my major task coming in was to get the school accredited as a
university.   So   we've been able to get all those things done,

retire the deficit and get those things done.
     But that's not the interest in terms of your interview.       The
interest is more on the curriculum and intellectual side, and I
was intensely involved with our faculty in redesigning some of
our curriculum and getting much more of the clinical

epidemiology, the population-based medical kind of issues, into
the curriculum. We've got a ways to go, still, but we're trying
harder, and then trying harder to integrate more now the life of

the community and its pressures into the intellectual life of the
school, such that we don't now have, as I had when we first got
here, community protest, because the community gets what it wants
through protest and acting-out.
     Now what we've been able to do is to create a shared vision

of health between the university and the community, that is
collaborative from its initial onset and design.     We now have the
community proactively bringing to us its resources, its ideas,

and we then must mold to fit those ideas, and vice versa.
                                                                       66

Mullan:     What is the community of Drew-King now?    Is it changing?

Watts was its birth.


Tuckson:    We are going through--and, again, this is one of the

reasons why I'm so pleased with all the experiences I've had at
the community-based level--politics and so forth, because I have
no illusions about what has to occur now.       This community, when
it first started the school, was 70 percent, or more, African-
American.    Now, it's 60 percent Latino, 40 percent African-
American.



Mullan:    And when you say, "this community,n it's the Watts--



Tuckson:    The south Central L o s Angeles.   Watts, Willowbrook,

Compton, part of it.    And so it's a changing community. And this

is not an easy transition.     People that are poor do not get into
very intellectual conversations about diversity.      When you're
fighting for the scraps at the bottom of the table, those are not
erudite, intellectual discussions.     Those are survival

discussions, and people are being very skillfully pitted against
each other in communities like this, and there is an appalling
lack of advocacy or leadership that says, "We must forge some
common shared visions about what life can really be like here in
Southern California, in south central Los Angeles, in Watts and

Willowbrook."    There really is no political figure who is able or

willing or interested in saying, "Let's figure out we come

together in our diversity." We have great opportunities as an
                                                                      67

academic center here, because, you know, the Latino first-
generation mother has a better infant mortality rate than white
women in this country, coming from poor places in Central and
South America.    What's going on here?   The third-generation
Latino mother has outcomes that look like African-Americans'.

Being in America is not helpful to them.      What's going on here?

What are the population-based social contributors to death and
disease here?    The issues of violence, the abused Latino girl
presents with a different history than the African-American

abused girl.     There are different ways in which people are

raised.    What do we learn? How do we apply what we learn from
these differences?     This is an absolute gold mine of intellectual
material for those of us who care about primary care and
population-based medicine.



Mullan:    What has been the drift of the student body?    I gather

now it's heavily Latino, or more Latino?


Tuckson:    We are reflecting more and more our community of

people.    This is an ongoing tension here.    Johns Hopkins sits in

the middle of an African-American community, but very few
African-Americans are medical students there.      They don't feel a
need to change.     Out here, at our school, we're wondering about
what should be the relationship. This year's medical school

class, in our freshmen class, ten of our twenty-four students

were African-American, ten were Latino, four were other.        This is

the first time we've had that many Latino students in our class.
                                                                           68

Will it be a trend?       I don't know.    We're all looking at those
issues, and it's an active area of inquiry here.
      There's no question, we celebrate diversity.          This is, by

far, the most ethnically diverse faculty and medical school
leadership in any university in the country.           We are very proud
of that.    We represent something that really will become, I
think, something of the America of the future.           We look like the
United Nations when we convene our faculty.            It's an
extraordinary experience. Now, that presents new challenges
other schools don't have, and we are going through great tensions

in the media here, in Los Angeles.         Somebody tried to say that we
were a racist school, because we had some tensions between an
East Indian physician and African-American physicians, and
because there was tension, they wanted to say that we were
somehow racist.
      Ninety-five percent of the faculty at USC is white.          They

don't have much tension, I guess.         So it's a very interesting

issue.    All of their chairmen are white.          It's a very interesting
way in which the media plays out.         There's   a real sense to the

media in this community, as opposed to my experience with the

Washington P o s t .   There's a real clear sense here that this L . A .

T i m e s media is not interested in having a shared vision of what

L.A. County can be.       It's very much interested in setting up

tensions and divisions, and I find that frustrating, even after

having gone and spoken to their editorial board.           And I have
direct, first-hand experience as to what their agenda is, and

it's painful.      There's an absence of leadership at the level of
                                                                    69

the governor on this point.      I mean, there's just nobody that
seems to be interested in trying to create an environment that
allows us to come together.


Mullan:    Is the principal tension Latino-Black?



Tuckson:    Well, no, because now it's getting even more

complicated, because now it's Latino against--you know, the
whites don't like the Latinos either, and, of course, all these
immigration issues, and all that sort of thing. And there's, of

course, tensions with the Asian-Pacific Islander community coming
in, and then, by the way, one of things we understand from a
population-based primary care point of view, is that there is no
such thing as a Latino community, that there are very important

differences at the clinical level, as well as at the public
policy level.    But at the clinical level that you and I care

about, the social determinants of disease for the El Salvadorean

may be very different than the Mexican ones, and they don't see
themselves as the same, either.     And, of   course, the Puerto Rican
community is very different, again, from what happens in Central
and South America.    So   that there are very important insights
that we must derive, and that's what I think the ultimate purpose
of what Drew is, at least here.



Mullan:    Do you get pressures from the African-American

community, either nationally or locally, since this was

established in that tradition, to hold the line?
                                                                      70

Tuckson:    Yes.   Yes.   There are many people that are very

concerned about that.     And I'm coming out of the Howard
University experience, and understanding that, I have questions
of my own.    But on the other hand, I'm completely aware of the
importance of what it means to serve a population of people, and

the diversity of that, and the strengths and benefits of that.        I
am certainly someone who sees that the future of America is going
to be a multi-dimensional, multi-cultural, multi-colored future,
and I am particularly excited about the opportunities of seeing
how we discover now the added value of the intermixture of all of

that, without losing the essence of your soul and your family
purposes and principles.      I think that there is a compatibility
there.


Mullan:    What about the difficulty of running a medical school in

this day and age? Are you getting all the chat about downsizing,

etc.?



Tuckson:    This is the worse time to be in academic medicine, I'm

sure, in the history of American medical education.     Everything
is turned upside down and on its ear.     Academic health centers
will undergo some of the most important revolutions imaginable.

The financial base is clearly at risk, at every level, both at

the federal government level, at the state government level, at

the local government level, and then, of course, the ability for

the faculties to generate clinical practice revenue to offset the
                                                                     71

costs of the academic enterprise are extremely threatened now
that we're in the competitive environment.
     The patient base necessary for clinical education and

clinical research is threatened because of the competition.     It

used to be that medical centers, ours included, had a guaranteed
population by not only mission, but by default.   Now the publicly

insured patient is being competed heavily by everybody else, and

it seems that the only people that we have left that are ours are
those that don't have any money at all to pay for their care,
which, of course, is incompatible with survival, as well as a
patient mix necessary for your residency programs to be

certified.

     So these are tough times in every way.   It means that there
will be a re-invention of our schools, and what Drew is in the
process of doing now is very aggressively re-discovering itself.
I just, over the weekend, had a board retreat, with my board, and
I pretty much let our board know that even though we're at the
strongest point in our history, that everything is going fairly

well for us, that we must take this beautiful model that we've
created, take a hammer, smash it all to bits, and reassemble it
in an entirely different way, that we have to be very aggressive
about creating a whole new idea of what an academic medical

center is, new partnerships, new collaborations, that are going

to be intensely community-oriented, but that will involve us with
partners that we never thought we would have before, and we're

aggressively about the business of doing that now.
                                                                     72

Mullan:    How did the board take it?



Tuckson:    They loved it.   I have a very good board.   I have a
board that isn't afraid.     Any board, first of all, when you lay
out the equation of reality, you say, "Listen, here are all the
phenomena, the environmental threats arrayed against us.     Now, if
you keep doing what you're doing, we're going to drive this car
right into a wall."    And everybody kind of realizes you'd better
go around the wall.


Mullan:    Question about primary care, back to our theme.   Both in

terms of your life and preparation as a generalist, how has that

played out, having wandered, one could argue, a long way from the
generalist laying-on of hands, but nonetheless, applicable, I'm
sure, to what you're doing, and how is generalism playing out, in
terms of the life of Drew and as you see the future of health

care?


Tuckson:    First, the training that I got as a generalist is the

training I use almost in everything that I do.    First, I believe
that the way in which I was taught to take a history, the way in
which I was taught to listen to people, to interview the patient,
to listen to the progression of symptoms, is the management tool

that I use the most.    The ability to formulate an impression

based on data, and to develop a treatment plan, with specific

steps that take into account all of the issues that are going on

at any one time, and then the willingness and the demand to
                                                                         73

monitor the success of your treatment plan, and then moderate it
and modify it, as you go along, becomes to me the logic that I
use in everything I do.


Mullan:    It sounds like dealing with uncertainty has got a lot in

common with training and your job.



Tuckson:    Absolutely, absolutely.   Second thing, as a generalist,

my appreciation that the one thing that I am, no matter what role
I play, is I'm a physician, that I am, first and foremost, a

physician.    That's my purpose, and that the larger purposes of
being a physician, and particularly a generalist physician, is
that we care about whether the patient lives or whether they die,

and the quality of health of that individual.      I'm not interested
in just the arm or the toenail.    I'm interested in the whole
person, and the quality of life for that person.      Because, as a
physician, I have that philosophical, moral and ethical mandate,
the things that I do as an administrator are in service to the
possibilities of health for that person and their family and the

community in which they live.    That's the r a i s o n d'6tre why you
get up in the morning and why you do what you do.      That's because
I'm a generalist.    I am practicing as a generalist.


[Begin Tape 2, Side 21



Mullan:    Dr. Tuckson, tape two, side two.
                                                                    74

Tuckson:    I understand, thoroughly understand, that the

possibilities for health of the person is very much intertwined
with the social forces in which that person lives, and I know
that the chances for prevention of disease, as well as to the
expression of the natural history of disease, is intimately tied
to a larger set of forces beyond what we do in the therapeutic
arena as one-on-one, doctor-patient relationship. And so every
decision that I make as an administrator ultimately deals with
those larger sets of issues, and I see that as being as
therapeutic as writing a prescription for penicillin or Keflex.
I think that does capsulate it in terms of how I view it.       I
mean, it really is all those phenomena.



Mullan:    How do you see generalism playing, in terms of the

school, its enterprise, and the country as a whole?


Tuckson:    I think it's going to be interesting, because we're

going to redefine the nature of what a generalist is.    I'm not
sure we know now anymore who's supposed to do what, and what the
value is of what each of us do.   The advanced practice nurse can
do 70 percent to 80 percent of what a family practitioner can do.
That's what they say, and I think they may be right.
     Because I have responsibility for a College of Allied

Health, I think very much about what our physician assistants are

learning, vis-a-vis what our family practitioners are learning.

What's the difference between the two, and how do you express the
                                                                     15

difference?     What is the value, financially and intellectually,
of what they do?
       I am very much interested in what the health care team is

about, the comprehensive health team, and I understand that the
physician general is probably outdated, while we go to the
physician generalists, who functions as a member of an
integrated, health delivery network that has a lot of people in
it that do valuable and important things.
       So   I think we have a lot to discover about who does what.

Now, while I say that, and given that now we want the primary

care physician to be very knowledgeable about population-based
medicine, to understand clinical epidemiology, and the
application of clinical epidemiology in service to very cost-
effective diagnostic judgments and very precise therapeutic
decisions, we're expecting that physician to understand
population dynamics, family issues, expecting him to understand
psychology and sociology, medical economics.     We're expecting him

to understand a whole lot of things which are going to be very
important, which stretches them out very much.
       While that's going on, we're about to undergo the real
dawning of the molecular biological revolution, because what
we've seen before ain't nothing compared to what we're about to
see.    And so, we're going to have the surgery done with enzymes,

before long.     You know, the use of robotics, distance surgery,
telemedicine, with all of those implications.

       And so the notion becomes then, who's going to be the

manager of the science-based interventions, and who's going to
                                                                         76

make the cost-effectiveness decisions for that, and who's going
to integrate those into the clinical practice guidelines, and
into the quality outcome measurements? And so it just seems to
me that we're asking a whole lot of this generalist physician.

     Meanwhile, the patient that comes to the generalist comes
now having been addicted to the Internet, having access to the
entire information base that we have.     So   the patient's
expectations and demands are going to be enormous in this new
moment.   And so you're going to have expect this generalist to be

up to date on all the science, which is growing at such a rapid

rate, be up to date on all the population-based social dynamic
issues, which are so critical to the work they do, be a member of
the team and know how to fit into the team, and then be able to
deal with the patient who is coming in, demanding an enormous
amount of time and intellectual energy, and will know more about

their disease than we will know.    Boy, what a load for the
generalist to have to deal with.
     And so I think we're going to come to some new
understandings, I think, in the future, about this.       I s e e this

as being a very exciting time.     I don't see this as being

problematic in the least.   I see it as being dynamic.         And, of
course, by the way, we also expect the generalist to be
integrating their work with the community, in a way in which

creates the social conditions and the environment that promotes

health and prevents disease.   Dynamic.   I'm excited.



Mullan:   What's the future hold for Reed Tuckson?
                                                                       77

Tuckson:    You know, I have no idea.    I don't know what I want to

be when I grow up.    I am now forty-five years old, and I do not
know what happens next.    My learning curve is faster than it's
ever been.    I am involved in corporate America.    I serve, for the
first time in my life, on a corporate board.      I am fascinated by
that experience and opportunity.      I really am beginning to think
much more about the role of corporate America in the solution to
these problems.    I am very concerned about the role of government

in the solution of these problems, and I'm trying now to really
think through and understand in different ways how you put
together community initiative with corporate initiative, with
public initiative, and create something that is sustainable and
makes sense, but I just don't know, Fitzhugh, what's next.       And I

don't know whether or not it means going ever upward and onward.
     I may decide to take a more focused approach, for the first
time in my life.     I would like to become very smart about a
smaller set of things.    There's a part of me that seems to be

going in the direction of going back to school and learning a lot
more about theology and medical ethics.      I'm finding a pull in

that direction.    I'm not sure where it's coming from.    I don't
know what it's all about, but I'm thinking a lot about it.       So,

we'll see.



Mullan:    Has your level of creativity and productivity worked

h a r d on your first marriage?   How does your work and your person

intersect around that?
                                                                      78

Tuckson:   I learned a lot of lessons from my failures in my first

marriage, and, yes, I was completely and totally preoccupied with
my work and my career and the pressures and being successful, and
having my child born the day medical school just about started.
Being in the intensive care unit the day school started.      I left

the intensive care unit--thank God my son is fine now--but
leaving the intensive care unit and then walking into my first

day at school really made it pretty tough.
     I was a young person as well.     I was very young, with all

that pressure.   My daughter was born in the middle of my second
year, when I wasn't doing well, and so it was a lot to carry.
And then, you know, trying to live up to the expectations that so
many people had for me.     I was really focused on work.   And the

other thing was, of course, that I had not even begun to grow as
a person by the time I got married.    The person that married my
first wife was not the person that didn't stay married to her.
It was another human being, someone who had a whole different way
of viewing the world, much broader, much more expansive, someone
that's really very different.
     NOW, absolutely, I understand in a way that I never
understood, the need for a complete life.    If you're going to be
able to be of any service to people, you must have integrity as a
human being.   You must be solid as a person.   W e make too many

decisions in medicine and in the jobs that I've had, we make too

many decisions that really require an integrated, mature, and

complete human being.     That means a person who is able to receive

love and give love; someone who's able to fulfill their
                                                                  79

commitments to other people on a personal level; someone whose
world view is informed by the passions of other people that are
loving, and that love you and care; a person who is connected to
their spiritual side, their religious side; someone who reads, is

thoughtful; someone who, when you have to make decisions, it
comes from a very deep and informed place, from a very special
and protected place from within; someone who cannot be easily
manipulated or pushed around by the passing fancy or by the
political or psychological pressures of the moment.   This
requires an integrated human being, and I'm just starting to get

there.


Mullan:   That's a good place to stop.



[End of interview]